Prior Authorization Specialist I, Grand Valley Primary Care, Full Time

Position Highlights

• Position: Prior Authorization
• Schedule: Monday – Friday
• Location: Grand Valley Primary Care

Responsibilities

• Gather Patient Information: Collect and review patient medical records, diagnosis codes, and procedure details to support the pre-authorization request.
• Verify Insurance Coverage: Confirm patient information and insurance coverage through verifying photo ID, insurance cards, and personal information.
• Submit Pre-Authorization Requests: Prepare and submit pre-authorization requests to insurance companies, adhering to their specific procedures and requirements.
• Follow Up: Monitor the progress of pre-authorization requests and follow up with insurance providers to expedite the approval process.
• Communicate with Healthcare Providers: Collaborate with healthcare providers to obtain any necessary documentation, notes, or additional information required for pre-authorization.
• Patient Education: Explain the pre-authorization process to patients, including potential out-of-pocket costs, and address any questions or concerns they may have.
• Document and Recordkeeping: Maintain detailed records of pre-authorization requests, approvals, denials, and communications with insurance companies and healthcare providers.
• Compliance: Ensure that all pre-authorization processes comply with relevant laws and regulations, including HIPAA (Health Insurance Portability and Accountability Act).

Requirements

• High school diploma or equivalent.
• Knowledge of medical terminology preferred.

Compensation

• $19.00 – $21.85 per hour, depending on education and experience.
• Discretionary bonuses, relocation expenses, merit increase, market adjustments, recognition bonuses, and other forms of discretionary compensation may be available.

Benefits

• Medical, dental, vision insurance
• Life Insurance